eThesis - Kauppakorkeakoulun sähköiset gradut

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For several years, the public dental care system of Finland has been facing difficulties concerning long waiting times and resource sufficiency. The demand for public dental services is likely to increase in coming years due to ageing population. The high demand and scarce resources of public dental services are building pressure on adopting new service models to ensure the availability and effectiveness of Finland's public dental services in the future.

Previous studies in the field of healthcare have shown that service delivery efficiency can be improved by designing the service production to match the actual needs of the patients. However, the highly variant needs of public sector patients make tailoring the service delivery challenging. By recognizing more homogeneous patient groups, the service delivery could be better designed to match supply and demand. For example, Lean techniques such as flexible, just-in-time (JIT) scheduling and open-ended appointments could be utilized to reduce slack and to improve the productivity of staff. This type of approach has become more common, especially in emergency clinics, aspiring to improve the flow of low-complexity patients. However, in dentistry, Lean thinking is still in its infancy.

This thesis poses a setting where the Finnish public dental care could assume two different operating modes: the traditional mode currently used by municipalities and a single visit (SV) mode. The SV mode would act as a fast-track for low-complexity patients who only require a reduced set of basic procedures by providing all necessary treatment during a single visit. To understand both of the modes, the operations of two municipalities - Jyväskylä and Espoo - and a private SV clinic - Megaklinikka - were analyzed. By mining data on staff, visits and performed procedures, the differences between the two modes in terms of operating model, patient & case mix and operational efficiency were examined. The operation of an additional SV service line in one dental care unit of Jyväskylä was also simulated.

Unlike the traditional model, the SV model allows dentists and hygienists to switch rooms and utilizes open-ended appointments and an ERP system to synchronize a JIT-flow of patients. Due to these features and a more homogenous patient and case mix, the SV model is able to produce ~90% more procedures and treat ~68% more patients annually than the traditional model in relation to the amount of clinical staff. Per one dentist, the SV model requires 20% less nurses and 120% more hygienists than the traditional model. The SV model results to 44% less visits, as 80% more procedures can be performed during a single visit. Roughly 40% of all patients and 70% of adult patients in municipalities could be classified as basic patients, meaning that for the majority of adult patients, the SV model could be applied. The simulation suggested that a SV service line would increase the annual procedure output of a municipal dental care unit by 7% without any additional staff. To harness this approach on a larger scale, the proportion of hygienists should be roughly doubled in municipalities. The results of this thesis show that the SV service model could offer a way to treat the majority of adult patients more efficiently in Finnish municipal dental care.